肾上腺囊性病变的临床分析

目的 提高肾上腺囊性病变的诊治水平。方法 回顾性总结40例肾上腺囊性病变患者资料，经影像学检查、手术及病理证实非肿瘤源性囊性病变31例，肿瘤源性囊性病变9例。结果 非肿瘤源性患者31例，其中单纯性囊肿5例，囊肿内出血感染或自发性出血所致高密度囊肿26例，均无激素活性症状，超声检查肿物内无血管，CT、MRI增强扫描肿物无强化，内分泌检查正常。肿瘤源性患者9例，其中嗜铬细胞瘤6例，皮质腺癌1例，节细胞神经瘤1例，皮质腺瘤1例，CT、MRI增强囊壁可强化，4例有激素活性症状，内分泌检查部分有相应激素水平升高。手术治疗38例，仅1例术后20个月因肿瘤转移而死亡，37例效果满意。结论 B超、CT、MRI可帮助诊断肾上腺囊性病变。单纯性或单侧自发出血性囊肿，无症状较小者，可定期观察，余者应手术治疗。     

膈神经损伤与臂丛上干节前损伤的关系

目的：了解膈神经损伤与臂丛神经上干节前损伤的关系。方法：应用Ｘ线、电生理技术及术中观察和电刺激等方法回顾性评价４２例臂丛神经损伤合并膈神经损伤患者的膈神经功能状态。结果：４２例中２６例Ｘ线表现为膈肌抬高及活动度下降，术中观察膈神经瘢痕化、质地变硬，电刺激无膈肌反应；１４例Ｘ线无异常，其中１０例术中观察同前，４例见膈神经正常或粘连，电刺激有反应但反应稍差；２例未获资料。电生理检查膈神经有损伤的１２例中，８例为完全损伤，相应Ｘ线有膈肌抬高，电刺激无膈肌反应，４例为部分损伤，Ｘ线无异常，电刺激见膈肌有反应但反应稍差。所有病例均经手术证实有上干节前损伤。结论：膈神经损伤时提示臂丛上干损伤的部位在节前。     

肾上腺囊性占位性病变的诊治分析

目的:提高肾上腺囊性病变的诊治水平。方法:回顾性分析38例肾上腺囊性病变患者的临床资料,经影像学、手术及病理检查证实,其中非肿瘤源性囊性病变30例,肿瘤源性囊性病变8例。结果:囊肿内出血、感染或自发性出血所致高密度囊肿24例,单纯性囊肿6例。前者均有不同程度的腰、背、腹部胀痛,其中3例伴有贫血,2例伴有肝功能异常;后者均无临床症状。B超检查肿物内无血管,CT、MRI增强扫描肿物无强化,内分泌检查正常。肿瘤源性囊性病变患者中,嗜铬细胞瘤5例,皮质腺瘤2例,节细胞神经瘤1例。5例有激素活性症状,内分泌检查部分有相应激素水平升高。B超、CT、MRI显示囊壁>0.3 cm,且厚薄不均,CT、MRI增强扫描后,囊壁可有强化,以嗜铬细胞瘤囊壁强化最为显著。手术治疗36例,除1例因车祸、1例因脑血管意外死亡外,34例效果满意。结论:B超、CT、MRI可帮助诊断肾上腺囊性病变。无论是非肿瘤源性肾上腺囊性病变,还是肿瘤源性肾上腺囊性病变,只要条件允许,均应手术治疗。     

CT在肩关节骨性Bankart损伤早期诊断中的应用

目的探讨CT在肩关节骨性Bankart损伤中早期诊断的应用价值。方法急诊收治26例单肩骨性Bankart损伤患者,除采用X线正位、轴位、穿胸位检查外,再予以CT检查,扫描层厚3 mm,并由1位影像科医师及1位骨科医师独立读片。结果 26例患者中,X线正位及穿胸位片仅发现11例存在关节脱位,并未发现骨性损伤;而CT检查发现26例患者均出现不同程度的骨性损伤。结论 Bankart损伤由于其解剖位置、骨折片大小而导致单纯X线检查无法确诊,CT检查在骨性Bankart损伤的早期具有更好的辅助诊断作用。     

老年结直肠癌合并急性肠梗阻：附116报告

目的探讨老年结直肠癌合并急性肠梗阻的处理原则和方法。方法回顾性分析5年间收治的116例老年(≥60岁)结直肠癌并发急性肠梗阻患者的临床资料。全组右半结肠癌并梗阻39例,左半结肠癌并梗阻64例,直肠癌并梗阻13例。采用右半结肠一期切除吻合治疗39例,左半结肠一期切除吻合62例,Hartmann手术9例,Dixon手术4例,肿瘤近端肠管造瘘2例。结果术后出现并发症17例(14.7%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡1例(0.9%)。115例(99.1%)痊愈出院。结论一定条件下,一期切除吻合治疗结直肠癌并发急性肠梗阻,是方便可行而安全有效的方法。     

腔镜辅助甲状腺手术临床适应证的探讨

目的:探讨微创腔镜辅助甲状腺手术(minimally invasive video-assisted thyroidectomy,MIVAT)的临床适用范围.方法:将91例单侧甲状腺手术按病变范围分组,45例病变≤3.0cm者行MIVAT(A组); 46例病变＞3.0cm者按患者要求,25例行MIVAT(B组),21例...     

Computed tomography in crossed aphasia (author's transl)]

Crossed aphasia, first described by Bramwell, is aphasia due to the hemispheric damage on the side of handedness. Crossed aphasia in a dextral is rare, and in Japan, there have not been more than ten cases in which the lesion is localized clearly. The cases reported till now have been verified mainly by necropsy. However, the time lag between the appearance of aphasia and the necropsy may affect the conclusion subtly. We consider that computed tomography (CT) can obtain almost the same findings as that by necropsy. However, at present there have been few cases diagnosed by CT except two cases reported by April et al. and Wechsler. We have reported a 47-year-old man in a dextral, who shows left hemiparesis and Broca's aphasia. His lesion is diagnosed by cerebral angiography and CT as the right hemisphere infarction due to right middle cerebral artery occlusion. CT localizes the lesion on the right hemisphere mainly sited deep region and sited wedge shaped cortical area of the fronto-parietal region. On the other hand, it localizes no lesion on the left hemisphere. CT in aphasia has been already reported by Hayward et al. In their report they concluded that correlation of lesion located by CT with aphasia type supported Geschwind's concept of aphasia. In this report we have discussed CT in crossed aphasia analysing our case and the two cases by April et al. and Wechsler. Three cases including our case are all Broca's aphasia, and we compare the lesion location of these three cases with Hayward's lesion located on Broca's aphasia. As the result of this, we can draw the conclusion that the lesion location by CT of these three cases and that of Hayward's report are almost symmetric.     

结直肠癌合并急性肠梗阻的外科治疗

目的 探讨结直肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析1993年7月至2003年7月间297例结直肠癌并发急性肠梗阻行急症手术治疗患者的临床资料。结果 右半结肠癌并梗阻103例，左半结肠癌和直肠癌并梗阻194例。其中一期切除吻合126例(右半结肠一期切除吻合98例，左半结直肠一期切除吻合28例)，全结肠切除或次全切除吻合者108例，Hartmann手术36例，Dixon手术9例，回乙状结肠或回直肠吻合捷径11例，肿瘤近端肠管造瘘7例。术后出现并发症53例(17．8％)，为切口感染、腹腔感染和肠瘘；死亡17例；280例(94．3％)痊愈出院。结论 一期切除吻合和结肠次全切除及全切除吻合手术治疗结直肠癌并发急性肠梗阻，是方便可行而安全有效的。     

Traumatic delayed intracerebral hematoma--clinical aspects

In order to seek the occasion and the management of traumatic delayed intracerebral hematoma, we selected 17 cases (4.2%) of traumatic delayed intracerebral hematoma (secondary lesion) from 401 cases of head injury, and compared them with other 11 acute traumatic intracranial multiple lesion (immediate lesion). The age ranged from 15 to 78 (except for a newborn hit on the cranium by his mother) and the average was 49 in secondary lesion and 58 in immediate lesion. Sex distribution, 15 males and 2 females in secondary lesion, and 10 males and 1 female in immediate lesion. Though both lesions were supposed to be resulted from almost same severe loads, secondary lesion took worse prognosis than the other: misery outcome (poor and fatal) of secondary lesion was 59% and that of immediate lesion 27%. Of 8 hypertensive cases who were all fatal, 7 were of secondary lesion. Secondary lesion could be expected in only 59% (10/17) by the initial X-CT performed 5.4 +/- 6.2 hr. after trauma. The predicted secondary lesion were classified into three types: salt and pepper like high density lesion (Lanksh's II type), low density lesion (Lanksh's I type) and isodensity mass lesion. The shortest interval between injury and the X-CT detection of secondary lesions was 10 hours and the longest interval was 69 hours (40 hours mean) in conservatively treated patients. In operated patients, the shortest and longest intervals were 8 and 84 hours, respectively (33 hours mean, except for one case who was not examined for 10 days after operation).(ABSTRACT TRUNCATED AT 250 WORDS)     

输尿管纤维性息肉的临床探讨

目的：探讨输尿管纤维性息肉的临床诊断及治疗方法。方法：回顾性分析总结7例输尿管纤维性息肉患者的临床资料，结合文献进行讨论。结果：7例共8侧输尿管纤维性息肉患者中，1例行病变节段输尿管切除加肾盂成形术，5例行病变段输尿管切除加端一端吻合术，1例行病变段输尿管、肾切除术。全部病例均获治愈并经病理证实。结论：IVU及逆行肾盂造影检查对诊断输尿管纤维性息肉有较大帮助，确诊依靠输尿管镜检查及活检。输尿管纤维性息肉的治疗以手术为主，应根据息肉的大小、数目、部位及肾脏受累程度选择息肉单纯切除术、输尿管部分切除术和肾盂成形术等。经输尿管镜息肉电切和电灼术是目前治疗本病的理想方法。     

Pseudomalignant osseous tumor of soft tissue: a case report and review of the literature

Pseudomalignant osseous tumor of soft tissues is a rare tumor of the hand. Histopathologic differentiation of this benign lesion from malignant lesions is difficult because mitotic figures are common in typical cases, but bizarre pleomorphic and hyperchromatic nuclei never occur. Wide excision is adequate in most cases, but ray resection is indicated when this benign lesion recurs after wide excision, invades the vital structures, or causes severe functional impairment. Review of the literature revealed 15 cases of this lesion in the digits of the hand, including our case. Of these 15 cases, misdiagnosis of malignancy in three cases and loss of function in an additional four cases led to ray resection.     

Localized fibrocystic disease of the femur: A report of three patients treated by curettage and bone graft

We have presented three cases of fibrocystic disease of the femur. Two of these patients had a purely cystic lesion, while the third had a solid fibrous lesion. In each of the three cases, the lesion described was the only such bone lesion present, and there was no evidence of any endocrine or hormonal disturbance. Although the gross and microscopic appearance of the solid lesion differs from that of the cystic lesion, it is probably true that both have as their pathogenic basis some localized congenital abnormahty in bone development. The clinical picture in both types of fibrocystic disease is very similar, and the surgical treatment in both types is the same. Each of these three patients was treated by curettement of the fibrocystic lesion followed by insertion of multiple bone grafts. This type of operation resulted in complete obliteration of the two purely cystic lesions and almost complete obliteration of the solid lesion.     

前十字韧带损伤合并内侧半月板ramp损伤

目的探讨前十字韧带损伤合并内侧半月板ramp损伤的发生率、诊断方法、修补术及其临床疗效。方法2002年4月至2005年4月,共进行333例单纯前十字韧带损伤重建术,陈旧性损伤(>3个月)215例,急性损伤(<3个月)118例。合并内侧半月板ramp损伤者89例,其中85例需手术修补。手术取腘绳肌腱、自体或异体骨-髌腱-骨移植物重建前十字韧带,同时应用全内缝合方法,经两个后内入路配合经髁间窝入路,利用缝合钩修补ramp损伤。前十字韧带损伤中,ramp损伤的总发生率为26.7%,其中陈旧性损伤的发生率为30.7%,急性损伤为19.5%。结果可随访者75例(88.2%),随访5～41个月,平均20.2个月。随访时采用主观症状观察、临床查体、二次关节镜手术观察及MR检查。其中二次手术观察25例,MR复查21例。在可随访的75例患者中,所有患者的主观症状及临床查体均呈正常表现;在二次关节镜手术观察的25例中,均全部愈合。在经MR复查的21例中,18例完全愈合,3例部分愈合。结论大约1/3的前十字韧带损伤合并有内侧半月板ramp损伤,陈旧性损伤较新鲜损伤合并ramp损伤的发生率更高。在重建前十字韧带的同时应修补ramp损伤,全内缝合方法是修补ramp损伤的很好方法,可以达到很高的愈合率。     

胰腺肿块性炎性病变的临床病理特征

目的:探讨胰腺肿块性炎性病变的临床病理特征。方法:回顾性分析肿块性慢性胰腺炎37例的临床资料。符合慢性胰腺炎临床诊断标准者为A组,共17例。行Whipple或胰体部分切除5例,各类内引流术12例。缺乏A组特点、曾拟诊为胰腺癌者为B组,共20例。行Whipple手术4例,胆肠内引流术16例。结果:A组除见胰腺局部质硬的肿块外,全部胰腺质硬者占88.2%;病理见胰腺纤维化瘢痕及少量炎细胞浸润,并有腺泡萎缩、减少,有残余胰岛及导管扩张或局灶钙盐沉积。B组中95.0%仅见胰腺局部质硬肿块,病理见胰腺纤维组织增生伴有不同程度的慢性炎细胞浸润。33例随访1~12年,均未发现胰腺癌变。结论:胰腺局灶性慢性炎症病变具有假瘤性胰腺炎的特点,行胆管空肠吻合术是有效的治疗方法。     

肾组织活检在移植肾功能损害的诊断与鉴别诊断中的价值

目的 探讨移植肾组织活检在移植肾功能损害的诊断与鉴别诊断中的价值。方法 对158例移植肾组织活检资料进行回顾分析。结果 158例中以急性排斥反应多见,共55例（34．8％）,移植肾改变35例（22．2％）,临界改变32例（20．2％）,慢性排斥反应13例（8．3％）,系膜增生性病变13例（8．3％）,急性肾小管坏死6例（3．8％）,新月体性肾炎、溶血性尿毒综合征和毛细血管内增生性肾炎各1例（0．6％）;血中环孢素A的浓度与急性排斥反应的发生率无明确正相关关系;临床诊断与肾组织活检结果尚存在一些差异。结论 肾组织活检对明确诊断及提高临床诊断的正确率及选择治疗方案有重要价值。     

Inflammatory pseudotumor of the liver in children: report of cases and review of the literature.

Two pediatric cases of inflammatory pseudotumor of liver were reported and compared with seven previously reported cases. Clinical presentation was variable but often consisted of fever and vague abdominal symptoms. These two cases were considered to be clinically malignant because angiographically one showed hypervascularity and the other showed the portal vein draining into the lesion to be occluded. There are four previous reports of similar cases complicated with occlusive phlebitis within and around the lesion. All but two of the reported cases underwent major hepatectomy or liver transplantation. However, because of the benign nature of the lesion, the treatment might be more conservative after adequate diagnostic procedures, including needle biopsy, are applied.     

Membranocystic lesion in lumbar yellow ligament.

STUDY DESIGN: An examination of surgical cases of membranocystic lesions in the lumbar yellow ligament between the fourth and fifth lumbar vertebrae. OBJECTIVES: To report the incidence and pathogenesis of membranocystic lesions of the yellow ligament in surgical specimens. SUMMARY OF BACKGROUND DATA: The membranocystic lesion has been observed not only in membranous lipodystrophy, but also in other conditions. However, there has been no report concerning this lesion in the yellow ligament. METHODS: Forty-four yellow ligaments excised in surgery were histologically reviewed. In eight cases, S-100 expression was investigated. In two cases, ultrastructural findings were examined. RESULTS: Membranocystic lesions were present in 8 (18%) of the 44 cases. The cases with the lesions had undergone surgery for spondylolisthesis (4 cases), sequestration-type disc herniation (2 cases), postradiation status (1 case), and spinal stenosis (1 case). Histologically, in all 8 cases, fibrosis was present around the lesion. In 5 of the 8 cases, chondrocytes were observed adjacent to the lesion, and nuclei positive for S-100 protein were observed in 4 cases. Nuclei of chondrocytes adjacent to the lesion also were positive for S-100 protein. Ultrastructurally, irregularly shaped cystic spaces surrounded by an electron-dense membranous structure, which were identical to those of membranous lipodystrophy, were observed. CONCLUSIONS: These results suggest that degeneration of the chondrocytes has a causal relationship to the formation of membranocystic lesions in the yellow ligament.     

肱骨近端复杂骨折的治疗策略

目的探讨肱骨近端复杂骨折的合理治疗策略,明确治疗方法和具体治疗手段。方法回顾总结32例肱骨近端复杂骨折病例资料。按Neer四部分骨折分类：一或二部分骨折8例采用保守治疗,18例[三部分骨折14例（其中4例伴肩关节脱位并有3例合并臂丛神经损伤）、四部分骨折4例]采用切开复位解剖型LC—DCP钢板内固定,6例（四部分骨折伴脱位）采用人工肱骨头假体置换术。结果32例均获随访,时问6～36个月,平均16个月。Constant Functional Score总体平均评分80．7分,总体优良率75％。无一例肱骨头坏死和关节脱位发生。结论对于肱骨近端复杂骨折只要根据骨折具体情况严格分型并选用合理治疗手段,术中充分保留肱骨头血供,有效修复肩袖和大小结节,坚强骨折内固定,尽早合理的关节功能锻炼,可以达到满意的治疗效果。     

Percutaneous transluminal angioplasty of subclavian arteries]

12 cases of subclavian arterial stenosis or obstruction were treated with percutaneous transluminal angioplasty (PTA). Atherosclerosis was considered as the cause of the arterial lesion in 7 cases. In 6 of them the lesion was located near the orifice of the subclavian artery. The lesion was 10.8 +/- 5.4 mm in length and 1.67 +/- 0.8 mm in diameter. After PTA the lumen was 6.58 +/- 1.11 mm in diameter. The clinical result was satisfactory. Arteries was found in 5 cases. Most of them had long segment obstructed lesion (46 +/- 36.6 mm in length, and 0.5 +/- 0.5 mm in diameter). The result of PTA was not satisfactory. The technique of PTA has been discussed.     

Pleomorphic adenoma of the palate in a child.

Pleomorphic adenoma of the palate is a rare entity in childhood. Only 4 cases of this lesion are documented in detail in the literature. We present a patient with this lesion and discuss the usefulness of magnetic resonance imaging (MRI) in the preoperative evaluation. A review of the previously reported cases is provided along with a discussion of the treatment of this lesion.